Employment Application

Step 1 of 8

We are delighted you have considered North Canyon Medical Center in your employment plans!

To enhance your understanding of the employment process at North Canyon Medical Center, we ask that you please read the following information before completing your application:

Job descriptions are available at the front desk and from the Human Resources office and should be reviewed prior to application for an open position. The description lists the essential functions of the job.

Resumes will be accepted when accompanied by a completed North Canyon Medical Center application. Applications that state “see Resume for further information” will not be accepted.

We will contact those candidates who we believe best meet the needs and qualifications of the position. If you do not hear from us within three weeks your application will be maintained in a file for future openings.

If you have any questions, please call the Human Resources Office at (208) 934-4433 ext. 1150.

North Canyon Medical Center’s Mission: “To improve the healthcare of people in our region.”

We are an Equal Opportunity Employer and Promote Diversity in our Workforce

NORTH CANYON MEDICAL CENTER IS PROUD TO BE AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, DISABILITY, VETERAN STATUS OR ANY OTHER STATUS PROTECTED BY LAW.

PERSONAL INFORMATION

Email:*

Enter EmailConfirm Email

How were you referred to North Canyon Medical Center?*

Walk-In

Job-Line

Internet Site

Newspaper

Referred by a North Canyon Medical Center employee

Who referred you?

Last Name*

First Name*

Middle Name

Social Security Number (Last Four Digits)*

Other names under which you’ve been employed

Street Address*

Street AddressCityStateZIP Code

Home Telephone*

Message Telephone*

Upload Your Resume (optional, but preferred)

Accepted file types: pdf, doc, docx.

Have you ever been previously employed by North Canyon Medical Center?*

Yes

No

If yes, what position:

Do you have relatives working at North Canyon Medical Center?*

Yes

No

If yes, what department?:

Position(s) for which you are applying:*

Salary Desired:*

Check all schedules you would consider:*

Full-Time

Part-Time (more than 24 hours)

Part-Time (less than 24 hours)

PRN

Please mark the days of the week you are available and willing to work:*

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Please mark the shifts you are available and willing to work:*

Days

Evenings

Nights

Weekends

Have you reviewed the job description(s) for the position(s) you are applying for?*

Yes

No

Can you perform the essential functions of the position with or without reasonable accommodation and without posing a direct threat to the safety of yourself and others?*

Yes

No

Are you under 18 years of age?*

Yes

No

If yes, indicate your age at last birthday:

Are you legally authorized to work in this country?*

Yes

No

Have you ever been convicted of a criminal offense other than minor traffic violations? Conviction will not necessarily disqualify you from employment. Each case will be reviewed on an individual basis considering such factors as recency, seriousness, and nature of the offense as it relates to the job for which you have applied.*

Yes

No

Not Sure

If yes or not sure, explain:

Have you ever been discharged from a position or asked to resign?*

Yes

No

If yes, please explain:

May we contact your present employer for references?*

Yes

No

If no, please explain:

PROFESSIONAL LICENSE, REGISTRATION OR CERTIFICATION DATA

Type license

License/Cer/Reg #

Issue Date

Expiration Date

Type license

License/Cer/Reg #

Issue Date

Expiration Date

Type license

License/Cer/Reg #

Issue Date

Expiration Date

Type license

License/Cer/Reg #

Issue Date

Expiration Date

EDUCATION

HIGH SCHOOL/GED

Name of School

City and State

Major

Type of Degree

"Other" Degree (please explain)

Did you graduate?

Yes

No

COLLEGE/UNIVERSITY #1

Name of School

City and State

Major

Type of Degree

"Other" Degree (please explain)

Did you graduate?

Yes

No

COLLEGE/UNIVERSITY #2

Name of School

City and State

Major

Type of Degree

"Other" Degree (please explain)

Did you graduate?

Yes

No

POST GRADUATE

Name of School

City and State

Major

Type of Degree

"Other" Degree (please explain)

Did you graduate?

Yes

No

WORK EXPERIENCE

Please list 10-year employment history. Explain any gaps over 1 month. Begin with your most recent employment and include any break in employment; use additional sheets if necessary. Resume will not be accepted as a substitute for a completed application. Incomplete applications will NOT be considered for processing.

REFERENCES

Give the names of three persons not related to you, whom you have known at least one year.Minimum of 2 reference required

REFERENCE #1

Name

FirstLast

Phone

Address

Street AddressCityStateZIP Code

Business

Years

REFERENCE #2

Name

FirstLast

Phone

Address:

Street AddressCityStateZIP Code

Business

Years

REFERENCE #3

Name

FirstLast

Phone

Address:

Street AddressCityStateZIP Code

Business

Years

CLARIFICATION STATEMENT

I agree to the following:

1. I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.

2. I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by Partners in Healthcare dba North Canyon Medical Center Corporation (hereinafter referred to as "North Canyon Medical Center") that such employment with North Canyon Medical Center is at will, for no specified duration and may be terminated by either North Canyon Medical Center or myself at any time, with or without cause. I understand that none of the documents, policies, procedures, actions, statements of North Canyon Medical Center or its representatives used during the employment process is deemed a contract of employment real or implied. I understand that no representative of North Canyon Medical Center except the CEO has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the CEO of North Canyon Medical Center.

3. In consideration for employment with North Canyon Medical Center, if employed, I agree to conform to the rules, regulations, policies and procedures of North Canyon Medical Center at all times and understand that such is a condition of employment. I understand that due to the nature of North Canyon Medical Center's business, attendance and punctuality are considered essential requirements of every job at North Canyon Medical Center and that poor attendance or tardiness will result in disciplinary action.

4. I understand that if offered a position with North Canyon Medical Center, I may be required to submit to a pre-employment medical examination, drug screening and background check as a condition of employment. I understand that unsatisfactory results from refusal to cooperate with, or any attempt to affect the results of these pre-employment tests and checks will result in withdrawal of any employment offer or termination of employment if already employed.

5. I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to North Canyon Medical Center and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information.

6. I hereby certify have not been excluded, suspended, or debarred from participating in or providing services in the Medicare/Medicaid programs (fraud & abuse) or any other federally funded healthcare program. I am not currently being investigated in any matter that could lead to exclusion from a Medicaid/Medicare program.

8. I understand that this application is considered current for 12 months. If I wish to be considered for employment after this period I must complete and submit a new application.

BY PROVIDING MY SIGNATURE, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.

Applicant Signature*

NOTE: We will keep this application for 12 months. If you wish to be considered for employment after 12 months or if you are interested in another position at a later date, please fill out a new application. Any questions should be directed to the Human Resource Office at (208) 934-4433 x1150.

BACKGROUND AND INVESTIGATION NOTICE/AUTHORIZATION

In connection with my application for employment at North Canyon Medical Center, I understand that a consumer report may be requested and may include information as to my character, work habits, credit, academic-credential verification, job performance, experience, and reasons for termination. I also understand North Canyon Medical Center may be requesting information concerning my motor vehicle operations history (when applicable), criminal and civil history via the Criminal History, Background Check process (in order to comply with all requirements of criminal history rules IDAPA 16.06.06 and IDAPA 16.05.05).

I authorize and release from all liability, without reservation, North Canyon Medical Center, and law enforcement agency, administrator, state/federal agency, institutions, schools, information service bureau, employer, employee, company or persons gathering or furnishing the above mentioned information.

I further acknowledge that a telephone facsimile (FAX) or photographic copy of this document will be as valid as the original.

Applicant Name*

Applicant Date of Birth*

Applicant Signature*

The Age Discrimination in Employment Act prohibits discrimination on the basis of age. Reported date of birth is used exclusively to verify an applicant’s background information

E-Verify: Enter your initials...*

North Canyon Medical Center participates in the E-Verify program with the Social Security Administration in conjunction with the Department of Homeland Security to determine eligibility of employment in the United States. Questions on this program should be directed to US Citizenship and Immigration Services at: http://www.uscis.gov/portal/site/uscis.

Mission

Powered by excellence, we are growing a medical organization that serves our communities.

Vision

We aspire to be your first choice for healthcare through an expanded network of medical services of the highest quality.